Body fat distribution, serum leptin, and cardiovascular risk factors in men with obstructive sleep apnea.

STUDY OBJECTIVE s: To determine whether traditional risk factors for cardiovascular disease (CVD) and regional fat distribution, especially the central obesity type and increased parapharyngeal fat pads, are associated with the degree of obstructive sleep apnea (OSA). To determine whether there are interrelationships between body fat, serum leptin levels, and the degree of OSA. DESIGN AND SETTING Prospective mono-center cross-sectional study in a university hospital in Germany. PATIENTS Eighty-five consecutive male patients who were referred for evaluation of suspected OSA. MEASUREMENTS AND RESULTS The major dependent outcome variable was the apnea-hypopnea index (AHI), the average number of apneas and hypopneas per hour of sleep, determined by overnight polysomnography. Independent measures were anthropometric data, body composition analysis (bioelectrical impedance analysis [BIA]), cardiovascular risk factor evaluation (smoking, hypertension, serum lipoproteins, diabetes or impaired glucose tolerance, uric acid, fibrinogen), and leptin. Adipose tissue quantification of the abdominal and neck regions was performed by nuclear MRI (NMR). Significant linear relationships of AHI with fasting blood glucose, uric acid, fibrinogen, body weight, body mass index (BMI), sum of fat skin folds, and percentage of body fat could be established, whereas there was no correlation with age. The presence of OSA was independent of smoking, hypertension, and lipoproteins. NMR scans showed that AHI was significantly correlated with intra-abdominal fat and subcutaneous abdominal fat, whereas subcutaneous fat in the neck region and parapharyngeal fat in the airway vicinity were not correlated. Leptin concentrations correlated with AHI and with biochemical markers of the metabolic syndrome (lipoproteins, glucose) but were not dependent on AHI. Logistic regression analysis found percentage of body fat (BIA) and BMI as good predictors of AHI > 10 with a sensitivity of 95.5% but a low specificity (46.2%). Multiple regression analysis identified the sum of fat skin folds, body weight, and BMI as good predictors for the degree of OSA. CONCLUSIONS We conclude that OSA is independent from most traditional risk factors for CVD. Regional body fat distribution predicts the presence and degree of OSA, but fat accumulation in the neck and parapharyngeal region are of minor importance. Leptin concentrations when controlled for body fat are not related to the degree of OSA.

[1]  K. Lam,et al.  Serum leptin and vascular risk factors in obstructive sleep apnea. , 2000, Chest.

[2]  V. Somers,et al.  Increases in leptin levels, sympathetic drive, and weight gain in obstructive sleep apnea. , 2000, American journal of physiology. Heart and circulatory physiology.

[3]  Jing Fang,et al.  Serum Uric Acid and Cardiovascular Mortality: The NHANES I Epidemiologic Follow-up Study, 1971-1992 , 2000 .

[4]  Bonnie K. Lind,et al.  Association of Sleep-Disordered Breathing, Sleep Apnea, and Hypertension in a Large Community-Based Study , 2000 .

[5]  P. L. Smith,et al.  Leptin, obesity, and respiratory function. , 2000, Respiration physiology.

[6]  T. Olsson,et al.  Leptin is associated with increased risk of myocardial infarction , 1999, Journal of internal medicine.

[7]  K. Nakao,et al.  Changes in intra-abdominal visceral fat and serum leptin levels in patients with obstructive sleep apnea syndrome following nasal continuous positive airway pressure therapy. , 1999, Circulation.

[8]  Daniel Levy,et al.  Serum Uric Acid and Risk for Cardiovascular Disease and Death: The Framingham Heart Study , 1999, Annals of Internal Medicine.

[9]  P. L. Smith,et al.  Leptin prevents respiratory depression in obesity. , 1999, American journal of respiratory and critical care medicine.

[10]  P. Ridker,et al.  A prospective study of fibrinogen and risk of myocardial infarction in the Physicians' Health Study. , 1999, Journal of the American College of Cardiology.

[11]  J. Terán-Santos,et al.  The Association between Sleep Apnea and the Risk of Traffic Accidents , 1999 .

[12]  P. Zimmet,et al.  Definition, diagnosis and classification of diabetes mellitus and its complications. Part 1: diagnosis and classification of diabetes mellitus. Provisional report of a WHO Consultation , 1998, Diabetic medicine : a journal of the British Diabetic Association.

[13]  G. Gibson Public health aspects of obstructive sleep apnoea. , 1998, Thorax.

[14]  J. Flier,et al.  Leptin inhibition of the hypothalamic-pituitary-adrenal axis in response to stress. , 1997, Endocrinology.

[15]  Jonathan P. Wyatt,et al.  Drug points: Quinolones may induce hepatitis , 1997 .

[16]  B. Spiegelman,et al.  Adipogenesis and Obesity: Rounding Out the Big Picture , 1996, Cell.

[17]  R. Leibel,et al.  Effects of gender, body composition, and menopause on plasma concentrations of leptin. , 1996, The Journal of clinical endocrinology and metabolism.

[18]  S. Redline,et al.  Recognition of obstructive sleep apnea. , 1996, American journal of respiratory and critical care medicine.

[19]  J. Habener,et al.  Leptin receptors expressed on pancreatic beta-cells. , 1996, Biochemical and biophysical research communications.

[20]  S. Klein,et al.  Relationship Between Insulin Sensitivity and Plasma Leptin Concentration in Lean and Obese Men , 1996, Diabetes.

[21]  S. Mudaliar,et al.  Acute and Chronic Effect of Insulin on Leptin Production in Humans: Studies In Vivo and In Vitro , 1996, Diabetes.

[22]  C. Fanelli,et al.  Plasma Leptin and Insulin Relationships in Obese and Nonobese Humans , 1996, Diabetes.

[23]  P. Björntorp The regulation of adipose tissue distribution in humans. , 1996, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[24]  R. Considine,et al.  Serum immunoreactive-leptin concentrations in normal-weight and obese humans. , 1996, The New England journal of medicine.

[25]  F. Abboud,et al.  Sympathetic neural mechanisms in obstructive sleep apnea. , 1995, The Journal of clinical investigation.

[26]  B. Singh,et al.  A simple measure of insulin resistance , 1995, The Lancet.

[27]  E. Fletcher,et al.  The relationship between systemic hypertension and obstructive sleep apnea: facts and theory. , 1995, The American journal of medicine.

[28]  D. Wetter,et al.  Smoking as a risk factor for sleep-disordered breathing. , 1994, Archives of internal medicine.

[29]  A. Kissebah,et al.  Regional adiposity and morbidity. , 1994, Physiological reviews.

[30]  L. Peterson,et al.  High prevalence of hypertension in sleep apnea patients independent of obesity. , 1994, American journal of respiratory and critical care medicine.

[31]  J. Hedner,et al.  Snoring and sleep apnoea in men: association with central obesity and hypertension. , 1993, International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity.

[32]  P. Suratt,et al.  Pharyngeal fat in obstructive sleep apnea. , 1993, The American review of respiratory disease.

[33]  P. Jennum,et al.  Snoring, sleep apnoea and cardiovascular risk factors: the MONICA II Study. , 1993, International journal of epidemiology.

[34]  T. Young,et al.  The occurrence of sleep-disordered breathing among middle-aged adults. , 1993, The New England journal of medicine.

[35]  A Tremblay,et al.  Visceral Obesity in Men: Associations With Glucose Tolerance, Plasma Insulin, and Lipoprotein Levels , 1992, Diabetes.

[36]  G. Bray,et al.  Pathophysiology of obesity. , 1992, The American journal of clinical nutrition.

[37]  J. Stradling,et al.  Relation between systemic hypertension and sleep hypoxaemia or snoring: analysis in 748 men drawn from general practice. , 1990, BMJ.

[38]  M. Kryger,et al.  Principles And Practice Of Sleep Medicine , 1989 .

[39]  S. Shea,et al.  Sites and sizes of fat deposits around the pharynx in obese patients with obstructive sleep apnoea and weight matched controls. , 1989, The European respiratory journal.

[40]  M Partinen,et al.  Long-term outcome for obstructive sleep apnea syndrome patients. Mortality. , 1988, Chest.

[41]  M. Kryger,et al.  Mortality and apnea index in obstructive sleep apnea. Experience in 385 male patients. , 1988, Chest.

[42]  D. Reed,et al.  CENTRAL OBESITY AND CORONARY HEART DISEASE IN MEN , 1987, The Lancet.

[43]  P. Björntorp,et al.  Abdominal adipose tissue distribution, obesity, and risk of cardiovascular disease and death: 13 year follow up of participants in the study of men born in 1913. , 1984, British medical journal.

[44]  Manning Feinleib,et al.  Obesity as an Independent Risk Factor for Cardiovascular Disease: A 26‐year Follow‐up of Participants in the Framingham Heart Study , 1983, Circulation.

[45]  J. Durnin,et al.  Body fat assessed from total body density and its estimation from skinfold thickness: measurements on 481 men and women aged from 16 to 72 Years , 1974, British Journal of Nutrition.

[46]  D. Rapaport,et al.  American Thoracic Society/American Sleep Disorders Association. Statement on health outcomes research in sleep apnea. , 1998, American journal of respiratory and critical care medicine.

[47]  N J Douglas,et al.  Neck and total body fat deposition in nonobese and obese patients with sleep apnea compared with that in control subjects. , 1998, American journal of respiratory and critical care medicine.

[48]  F A Mathewson,et al.  Relation of body weight to development of ischemic heart disease in a cohort of young North American men after a 26 year observation period: the Manitoba Study. , 1977, The American journal of cardiology.

[49]  W C Dement,et al.  The sleep apnea syndromes. , 1976, Annual review of medicine.

[50]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .